23% of Disability Claims Processed Incorrectly

Post date: Jun 21, 2011 9:33:34 PM

May 21, 2011 • Ben Krause

In a recent audit of the VA Dis­abil­ity Com­pen­sa­tion Sys­tem at 16 Regional Offices, the VA Office of the Inspec­tor Gen­eral esti­mates that the rat­ing staff incor­rectly processed 23 per­cent of the 45,000 claims inspected.

The IG inves­ti­gated offices through­out the US and focused mainly on the han­dling of the fol­low­ing five types of claims: 1) extra-schedular 100 per­cent dis­abil­ity eval­u­a­tions (TDIU), 2) PTSD, 3) TBI, 4) Her­bi­cide Expo­sure, and 5) Haas (Haas v Nichol­son: “blue water” claims from Viet­nam Agent Orange expo­sure). The processes eval­u­ated ranged from mail han­dling to actual dis­abil­ity per­cent­age awards.

Of the 16 Regional Offices, Bal­ti­more, MD and Anchor­age, AK scored the low­est in com­pli­ance with VA stan­dards. Both failed to meet 14 of the 15 process require­ments. Extended man­age­ment vacan­cies were cited as one of the link­ing fac­tors between all poorly per­form­ing Regional Offices. Because of the vacan­cies, these offices lacked con­ti­nu­ity and proper over­sight. As a result, pro­ce­dures were not devel­oped or imple­mented to cor­rect pre­vi­ously iden­ti­fied prob­lems.

The Haas vs. Nichol­son claims had the high­est rate of error. In Jan­u­ary, the VA released a report claim­ing the TDIU errors would have resulted in an over­pay­ment of over $1.1 bil­lion by 2016. While this may be true, the VA made no effort to project the amount of dol­lars not paid to incor­rectly denied vet­er­ans who would oth­er­wise have qual­i­fied. It’s quite pos­si­ble that this amount might be much higher in the other direc­tion.

Mean­while, at 83 per­cent of the Regional Offices, Haas claims had a higher instance of the VA fail­ing to fol­low VA pol­icy (5 of 6 sur­veyed failed the stan­dard). Haas claims involve vet­er­ans who were likely exposed to Agent Orange but never set foot in Viet­nam. Prior to the 2006 Haas v Nichol­son deci­sion, mainly vet­er­ans who set foot on Viet­namese soil or road on craft up rivers in Viet­nam were enti­tled to the pre­sump­tion of expo­sure. Now, the VA is still attempt­ing to catch up to the claims back­log that was caused by the VA appeal of that 2006 deci­sion. In 2009, the deci­sion for Haas was upheld and the VA has since strug­gled to main­tain con­ti­nu­ity between offices in how the back­logged claims are processed. The report stated some of these claims were incor­rectly denied after the ini­tial Haas deci­sion was upheld.

Vet­er­ans receiv­ing denials or low-ball rat­ings within the past year for any dis­abil­ity rat­ings may want to con­sider imme­di­ately look­ing over their deci­sion and request a copy of their VA claim file. If the time passed since the deci­sion is close to the 12-month appeal dead­line, con­tact your Vet­eran Ser­vice Offi­cer to dis­cuss the pos­si­bil­ity of appeal­ing it, if war­ranted. There are both “for pay” and Pro Bono VSO’s. I sug­gest talk­ing to the Pro Bono peo­ple first. Try to find one you trust who will han­dle your claim in a pro­fes­sional man­ner.

Vet­er­ans already denied at the Board of Appeals review may want to con­sider speak­ing with a Vet­er­ans Law Attor­ney in their area, since VSO’s can­not rep­re­sent vet­er­ans before the US Court of Appeals for Vet­er­ans Claims. Two resources worth look­ing at are the National Orga­ni­za­tion of Vet­er­ans Advo­cates (NOVA) and National Vet­er­ans Legal Ser­vices Pro­gram (NVLS). There are many other attor­neys out there as well. A sim­ple Google search could ren­der qual­ity results as well. Just be sure the lawyer is accred­ited by the Depart­ment of Vet­er­ans Affairs. Of course, con­fi­dent vet­er­ans can always opt to rep­re­sent them­selves Pro Se before the court, as well.

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